heparin protocol

  1. At my institution we have weight based heparin protocal orders. We have a lot of trouble getting a therapeutic ptt. The patient gets stuck every 6 hours until we get 2 therapeutic Ptt's in a row. Then the Ptt goes to daily. It just seems like the patient gets stuck a whole lot more with protocols. Does anyone else have problems with this?
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    About rookreck

    Joined: Nov '05; Posts: 12


  3. by   pricklypear
    We only need 1 therapeutic level before we go to daily. That's how it was at my last job as well. Do you find that you often don't get a therapeutic level the second time? If you are consistently getting 2 in a row, then perhaps the protocol needs to be revised?
  4. by   rookreck
    We give a bolus with the initial start of heparin. So 99% of the time the first ptt is greater than 110. We then hold the heparin for 1 hour and decrease by so many units and repeat in 6 hours. It just seems like the patient is the one that suffers, by getting so many sticks.
  5. by   hrtprncss
    Wow 99 percent above 110? If I can ask, how much initial bolus do you guys give?

    EDIT: Just wanted to add that we now use Anti Factor Xa as oppose to PTT for heparin gtt.
    Last edit by hrtprncss on Dec 1, '05
  6. by   rookreck
    It is all weight based. I don't know the exact amounts.
  7. by   zambezi
    We also start with a weight based heparin bolus (I want to say 50 units/kg, but I can't remember so I could definately be wrong). Then we run the actual drip at 15 units/kg/hr. We do a PTT in 6 hours. Everything time we make a change we have to draw another PTT (Q6hr) Once we reach therapeutic range, then we just check the PTT daily. It does seem like a of pokes for the patient, but it is for their safety...
  8. by   hrtprncss
    What I've usually seen is either a fixed 5000 unit bolus or 80units/kg initial bolus but of course I maybe wrong, I should ask the in house pharmacist.